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High-Risk Thyroid Nodule FNA — RACP Adult Medicine MCQ

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EasyEndocrinologyHigh-Risk Thyroid Nodule FNARACP Adult Medicine

A 45-year-old woman has a 2.5 cm thyroid nodule with high-risk ultrasound features (solid, hypoechoic, taller-than-wide, microcalcifications, irregular margins). TSH is normal. What is the most appropriate next step?

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Correct answer: E — Fine needle aspiration biopsy

A thyroid nodule ≥1 cm with high-risk ultrasound features (TI-RADS 5 or EU-TIRADS 5: solid, markedly hypoechoic, taller-than-wide, irregular margins, microcalcifications) requires FNA biopsy. FNA is the gold standard for thyroid nodule evaluation. Results are reported using the Bethesda System (I-VI). A normal TSH excludes hyperfunctioning nodules (which have very low malignancy risk and do not need FNA).

Reference: ATA – 2015 – Thyroid Nodule Guidelines; eTG Endocrine 2024